When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

A member of our extended family is a nurse practitioner. Recently, we talked about her practice providing care for several homebound, older patients. She tracks their health with her employer’s proprietary EHR, which she quickly compared to a half-dozen others she’s used. If you want a good, quick EHR eval, ask a nurse.

What concerned her most, beyond usability, etc., was piecing together their medical records. She didn’t have an interoperability problem, she had several of them. Most of her patients had moved from their old home to Florida leaving a mixed trail of practioners, hospitals, and clinics, etc. She has to plow through paper and electronic files to put together a working record. She worries about being blindsided by important omissions or doctors who hold onto records for fear of losing patients.

Interop Problems: Not Just Your Doc and Hospital

She is not alone. Our remarkably decentralized healthcare system generates these glitches, omissions, ironies and hang ups with amazing speed. However, when we talk about interoperability, we focus on mainly on hospital to hospital or PCP to PCP relations. Doing so, doesn’t fully cover the subject. For example, others who provide care include:

College Health Systems

Pharmacy and Lab Systems

Public Health Clinics

Travel and other Specialty Clinics

Urgent Care Clinics

Visiting Nurses

Walk in Clinics, etc., etc.

They may or may not pass their records back to a main provider, if there is one. When they do it’s usually by FAX making the recipient key in the data. None of this is particularly a new story. Indeed, the AHA did a study of interoperability that nails interoperability’s barriers:

Hospitals have tried to overcome interoperability barriers through the use of interfaces and HIEs but they are, at best, costly workarounds and, at worst, mechanisms that will never get the country to true interoperability. While standards are part of the solution, they are still not specified enough to make them truly work. Clearly, much work remains, including steps by the federal government to support advances in interoperability. Until that happens, patients across the country will be shortchanged from the benefits of truly connected care.

We’ve Tried Standards, We’ve Tried Matching, Now, Let’s Try Money

So, what do we do? Do we hope for some technical panacea that makes these problems seem like dial-up modems? Perhaps. We could also put our hopes in the industry suddenly adopting an interop standard. Again, Perhaps.

I think the answer lies not in technology or standards, but by paying for interop successes. For a long time, I’ve mulled over a conversation I had with Chandresh Shah at John’s first conference. I’d lamented to him that buying a Coke at a Las Vegas CVS, brought up my DC buying record. Why couldn’t we have EHR systems like that? Chandresh instantly answered that CVS had an economic incentive to follow me, but my medical records didn’t. He was right. There’s no money to follow, as it were.

That leads to this question, why not redirect some MU funds and pay for interoperability? Would providers make interop, that is data exchange, CCDs, etc., work if they were paid? For example, what if we paid them $50 for their first 500 transfers and $25 for their first 500 receptions? This, of course, would need rules. I’m well aware of the human ability to game just about anything from soda machines to state lotteries.

If pay incentives were tried, they’d have to start slowly and in several different settings, but start they should. Progress, such as it is, is far too slow and isn’t getting us much of anywhere. My nurse practitioner’s patients can’t wait forever.

4 responses to "Is Interoperability Worth Paying For?"

Interoperability is a means, not an ends. We need to focus on UX — User Experience. This can be classic user alone, but I really mean both provider and patient. They both need their User Experience optimized, improved, not sucking.

Only when we focus on outcomes will it be obvious what needs improvement. Yes interoperability needs improvement. But not simply to get interoperability, but to get better UX.

CMS has made it clear that interoperability is the way we are headed as an industry. EHR vendors are working hard to find ways to make this as easy as possible for the providers, but nothing has been quite easy enough. Each year we see new improvements to the interoperability features in EHRs and we also see providers becoming more accustomed to this workflow.

Even though many providers are on board, we see a lot of practices and organizations opting out of HIEs because they don’t see enough benefits yet. It’s become a repeating cycle and we seem to be stuck – providers are angry that they can’t access all the information they need on the EHR so they stop using all of the features. This leaves us with empty HIEs and frustrated clinicians.

While I do agree that we need to pick up the pace on development and implementation of solutions to data transfer between providers and organizations, we also need to be patient and remember that Rome wasn’t built in a day.

I feel this way about the patient portals. I am an office supervisor and a patient as well and I sympathize with our patients. I would love one central location to sign in and see all my health records, I am not going to learn a new username and password for all the different providers that I see – make it usable to both patient and providers.